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When pressure for perfection gets dangerous

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As a high-achieving teenager, Maria*, now 40, felt pressure to be perfect in every aspect of her life: in school, sports and friendships. Eventually the pressure led to disordered eating and bulimia, which she hid from her family. “When they finally discovered that I had a problem, they didn’t understand. So I never had the support system at home to get me the professional help I needed.”

After a health scare in her 20s, Maria found Jennifer Naticchia, MD, a fellowship- trained sports medicine and family
medicine physician.

“Dr. Naticchia was my safety net; she really saved my health.”

Dr. Naticchia notes Maria’s story is common in a society that rewards perfection, especially among competitive athletes: “Some take the pressure in stride while others are driven to a dangerous pattern of overtraining and diet that is the root of the female athlete triad, a condition with long-term health consequences.”

The triad refers to disordered eating, amenorrhea (lack of a menstrual period) and osteoporosis. Dr. Naticchia explains the link: “A lack of nutrition and inadequate body fat can lead to missed periods and lower estrogen levels. Since estrogen is essential to bone health inwomen, significant reduction can cause irreversible bone loss.”

Thinness isn’t always a sign, says Dr. Naticchia: Any type of disordered eating can lead to amenorrhea, which is easy to hide.”

The behaviors may start gradually and, at first, the athlete may get positive reinforcement. Limited weight loss may result in increased speed or compliments on appearance, but over time, obsession with diet and exercise can weaken the athlete.

The “female athlete triad” is actually a bit of a misnomer. That’s because pressure from a wide range of situations, including school, work and relationships, can lead to disordered eating risks for all women, at any age.

Dr. Naticchia says: “The good news is that there is a strong chance of full recovery with early treatment and coordinated care through a physician, counselor and nutritionist.”

* Patient’s name has been changed